Cytomegalovirus (CMV) retinitis is the most frequent ocular opportunistic infection among patients with AIDS and a major cause of visual impairment and blindness. Although highly active antiretroviral therapy (HAART) has reduced the incidence of CMV retinitis by 80 to 90 percent, it remains a substantial cause of visual impairment among patients with AIDS.
In this study, researchers analyzed the five-year mortality and ocular outcomes of 503 AIDS patients with CMV retinitis. Participants were classified as having previously diagnosed CMV retinitis and immune recovery (CD4+ T cells ≥100 cells/μl), previously diagnosed retinitis and immune compromise, or newly diagnosed CMV retinitis (diagnosis <45 days before enrollment). Patients were followed up every three months with medical history, ophthalmologic examination, laboratory testing, and retinal photographs.
The results showed that despite the availability of HAART, AIDS patients with CMV retinitis remain at increased risk for long-term mortality, retinitis progression and complications, and visual loss. Overall mortality was 9.8 deaths/100 person-years (PY), the rate of retinitis progression was 7.0/100 PY, the rate of retinal detachment was 2.3/100 eye-years (EY), the rate of immune recovery uveitis was 1.7/100 PY, and the rates of visual impairment (<20/40) and legal blindness (≤20/200) were 7.9/100 EY and 3.4/100 EY, respectively. Rates for all of the above were significantly lower for the previously diagnosed retinitis and immune recovery patients than the newly diagnosed CMV retinitis patients.
Although the event rates generally tended to decline over time, they never reached zero, suggesting that ongoing monitoring is needed for at least five years. Although HAART has dramatically lowered mortality and the incidence of opportunistic infections among patients with HIV infection, more than one third of patients with newly diagnosed HIV in the United States will progress to AIDS within one year, and 44 percent will progress within three years, presumably because of late testing. Therefore, a substantial portion of patients with HIV infection are at risk for opportunistic infections, including CMV retinitis. Among those with CMV retinitis, treatment with HAART can lead to immune recovery and the possibility of prolonged survival. Thus, data on long-term outcomes among these patients will provide useful prognostic information.